Therapy for Pediatric Clients with Mood Disorders Case Study

Therapy for Pediatric Clients with Mood Disorders Case Study

  • Review this week’s Learning Resources. Consider how to assess and treat pediatric clients requiring antidepressant therapy.

The Assignment

Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client.Therapy for Pediatric Clients with Mood Disorders Case Study. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

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SEE ATTACHED OF THE DECISIONS MADE FOR POINTS # 1, 2 AND 3.

  • At each decision point stop to complete the following:
    • Decision #1
      • Which decision did you select?
      • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
      • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
      • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?Therapy for Pediatric Clients with Mood Disorders Case Study
    • Decision #2
      • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
      • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
      • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
    • Decision #3
      • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
      • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
      • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?Therapy for Pediatric Clients with Mood Disorders Case Study
  • Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources.Therapy for Pediatric Clients with Mood Disorders Case Study. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Week 2: Therapy for Pediatric Clients With Mood Disorders

Mood disorders can impact every facet of a child’s life, making the most basic activities difficult for clients and their families. This was the case for 13-year-old Kara, who was struggling at home and at school.Therapy for Pediatric Clients with Mood Disorders Case Study. For more than 8 years, Kara suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues. As a psychiatric mental health nurse practitioner working with pediatric clients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

 

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

 

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

  • Chapter 6, “Mood Disorders”
  • Chapter 7, “Antidepressants”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

 

Note: To access the following medications, click on the The Prescriber's Guide, 5th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

 

Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf

 

Rao, U. (2013). Biomarkers in pediatric depression.Therapy for Pediatric Clients with Mood Disorders Case Study. Depression & Anxiety, 30(9), 787–791. doi:10.1002/da.22171

Note: Retrieved from Walden Library databases.

Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf

 

Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale--Revised. Los Angeles, CA: Western Psychological Services.

Note: Retrieved from Walden Library databases.

Required Media

Laureate Education (2016e). Case study: An African American child suffering from depression [Interactive media file]. Baltimore, MD: Author.

 

Note: This case study will serve as the foundation for this week’s Assignment.

 

Optional Resources

El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. doi:10.1007/s00787-014-0558-3

Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. doi:10.1111/jpc.12655

Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. doi:10.2989/17280583.2014.938497

 

Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression

 

BACKGROUND INFORMATION

The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.Therapy for Pediatric Clients with Mood Disorders Case Study

  • Client complained of feeling “sad”
  • Mother reports that teacher said child is withdrawn from peers in class
  • Mother notes decreased appetite and occasional periods of irritation
  • Client reached all developmental landmarks at appropriate ages
  • Physical exam unremarkable
  • Laboratory studies WNL
  • Child referred to psychiatry for evaluation
  • Client seen by Psychiatric Nurse Practitioner

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MENTAL STATUS EXAM

Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted.Therapy for Pediatric Clients with Mood Disorders Case Study. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.

The PMHNP administers the Children's Depression Rating Scale, obtaining a score of 30 (indicating significant depression)

 

RESOURCES

  • Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale--Revised. Los Angeles, CA: Western Psychological Services.

 

Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression

 

Decision Point One

 

Begin Zoloft 25 mg orally daily

RESULTS OF DECISION POINT ONE

  • Client returns to clinic in four weeks
  • No change in depressive symptoms at all

Decision Point Two

Therapy for Pediatric Clients with Mood Disorders Case Study

Increase dose to 50 mg orally daily

 

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Depressive symptoms decrease by 50%. Cleint tolerating well

Decision Point Three

 

Maintain current dose

 

Guidance to Student
At this point, sufficient symptom reduction has been achieved. This is considered a “response” to therapy. Can continue with current dose for additional 4 week to see if any further reductions in depressive symptoms are noted. An increase in dose may be warranted since this is not “full” remission- Discuss pros/cons of increasing drug dose with client at this time and empower the client to be part of the decision. Therapy for Pediatric Clients with Mood Disorders Case Study.There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy.

 

Decision Point One

 

Select what the PMHNP should do:

Begin Zoloft 25mg orally daily

RESULTS OF DECISION POINT ONE

  • Client returns to clinic in four weeks
  • No change in depressive symptoms at all

Decision Point Two

Begin Zoloft 25 mg orally daily

Begin Paxil 10 mg orally daily

Begin Wellbutrin 75 mg orally BID .Therapy for Pediatric Clients with Mood Disorders Case Study

magellan-psychotropicdrugs

PSYCHOPHARMACOLOGY-PRINCIPLES_IN_USING_PSYCHOTROPIC_MEDS_IN_CHILDREN_AND_ADOLESCENT